Patient with initials LM was admitted to the facility on 06/04/2017. The patient is female and aged 93 years. Further details indicate that she is widowed and has six kids who are all married. A primary examination of blood pressure, temperature, height, and weight was done as required. The outcome of the examination is stated in the health diagnosis section.
History of present illness
The patient has a fracture in her leg and also admits to feeling pain in other parts of the body such as her back and the right shoulder. Upon admission, her blood pressure is at BP 175/72 which indicates primary hypertension. She also has difficulty comprehending what she is told and seems to lose concentration quite easily. This indicates unspecified dementia without behavioral disturbance.
Her current fracture is associated with weakened bones due to age-related osteoporosis. Part of the reason as to why she takes long to hear/understand any communication is because one of her ears suffers from partial hearing loss. Her complaints about lack of bowel movements is a sign of gastroesophageal reflux disease without esophagitis.
All of her health diagnosis are indications of a Major depressive disorder.
Significant client health history (include family history)
LMs hypertension could be genetic due to her family history. Her family also has a history of obesity and Parkinsons disease. These two are however ruled out because the patients height, weight, and the resultant BMI are average. This confirms that she is not obese. As for Parkinsons, her limbs are fine without the severe tremors associated with the disease.
In the past, LM used to drink alcohol and smoke. Smoking could be a partial cause of lung sounds. Her lifestyle when she was younger was filled with adventure, and she could exercise once in a while but not regularly.
LM may have experienced trauma when her husband died six months before her admission to the facility, hence causing her depression. This is common, especially for people in old age, who have few friends besides their spouses.
Pathophysiology of primary diagnosis
Major depressive disorder is often known to showcase different clinical and etiological characteristics for different patients. The common pathophysiological examinations are based on neurobiological theories supported by their strengths and weaknesses evaluation. Pathophysiology of the Major depressive disorder is aided by psychosocial integrity, stress hormones, and study of neurotransmitters such as serotonin and dopamine. Another significant indicator is also the sleep patterns which depend on circadian rhythms (Hasin, Goodwin, Stinson & Grant, 2005).
The patient (LM) shows signs of depression such as trouble in concentration, restlessness, fatigue, persistent pains, and memory loss (Nelson & Charney, 1981). Other symptoms of depression include digestive problems which the patient has in the form of constipation. She reported lack of bowel movement for two days despite lack of pain when the abdomen is palpated. Considering that LM is a 93-year-old with a previous diagnosis of hypertension, a current BP of 138/61 is a good improvement from 175/72.
The patient, LM considers her admission to the facility equivalent of being robbed of her independence. She was uncomfortable with the new environment but has progressively begun to adapt. As for the fractured leg, she feared surgery, only to respond in a more tolerant attitude when she saw the result of the treatment being given.
LM is a flexible and reasonable person, but at the same time, she is very emotional. When talking about her husband and their memories together, she sheds tears. The patient evidently misses her husband, and anything that brings back memories seems to make her cry.
She takes part in all the activities like going to the salon to have her hair and nails done. Making new friends seems to be her way of diverting thoughts from the memories of her husband and her crying has reduced in comparison to the earlier days after being admitted. Her daughter visits her every Friday and she, therefore, feels loved.
Compliance with health care plan
She likes to follow up on the results of physical therapy sessions, labs, and x-ray. Even though she takes time with activities of daily living (ADLs), she is willing to do them herself with minimal help. She is also responsive when asked questions by the aid.
Clients preferences unique to culture: hygiene, diet support
LM needs help with daily ADLs such as eating and dressing. Despite her desire to be independent, she has somehow grown fond of the health aide who helps her with the bath every Monday and Friday. She even considers this a bonding moment and shares feelings with the aide.
Role: marital status, children, parents, etc.
LM was married to her husband for 52 years before his death parted them. For people who have stayed together for such a long time, loneliness creeps in when they can no longer be together. She has six kids, four sons, and two daughters. Her joy was in raising their six kids as her husband ran activities in the pharmacy store he owned. Her life was filled with happiness as she enjoyed spending time with family. All her kids are married and have families meaning she has grandchildren. Her illness results from the death of her husband with whom she used to engage in many activities together, hence her current loneliness.
LM has a strong Christian faith. She states that she has always felt obligated to attend the Church of the Latter Day Saints. She believes that being at the facility denies her the opportunity to follow her routine and go to church on Sundays.
Clients statements that reflect joy/purpose of living vs. hopelessness
LM has no regrets about how she had lived her life. She is pleased with her priorities such as education for her children and traveling with her husband. Her husbands death makes her hopeless due to the boredom and loneliness.
Clients inner strength/weaknesses
Her family is her strength and losing her husband was the saddest thing in her life. Staying alone makes her sad, but she always looks forward to family visits. Her weakness is that she lets her emotions take over to the extent of being unable to reason.
As per Eriksons Developmental Stages, LM falls under the ego integrity vs. despair level. This applies to persons over the age of 65 and is shown by how the patient contemplates her past life. She is happy that she and her husband were able to provide a good education for all the kids. On the other hand, she despairs over the death of her husband.
For LM, it is unusual for her to stay in the facility and to be taken care of. This is because she had gotten used to taking care of her husband and her kids. She also felt capable of performing daily activities, but the pains on her back and leg could not allow. The role changes were unfamiliar to LM.
Her initial home was in Seattle before she and her husband moved to St. George. After that, her husband died making her a widow and leaving her lonely. At some point, she was also used to having a big family of six kids who grew up and moved out one-by-one to start their own families. Being checked into the facility is also a significant change in her life because she is not used to the people and the environment.
She never had significant health problems when she was young. But she started having health problems after 70. Her career as a homemaker as well as her husband's pharmacy store had generated good money which she put into savings. The savings make her worry free on medical expenses because she also has a pretty good health insurance cover.
Significance of Assessment Findings
Upon admission, it was evident that the patient, LM had high blood pressure. The cardiovascular report based on the latest examination shows an improvement from 175/72 to 138/61. This result is based on medications undertaken as well as the patients mental status. The mental status and mood changes of the patient when at the facility indicate nervousness and anxiety during her first few days of admission. Later on, she was able to accept her situation and remain relaxed and comfortable at the facility (Carney et al. 1988).
The physical examination which deduced back pains and leg pains support the diagnosis of a major depressive disorder. The tiredness and shortness in breathing results in fatigue which in the end creates hopelessness in the patient. For LM whose history is one filled with adventure, she was stressed that she could no longer walk long distances and perform chores on her own. From the assessment findings, major depressive disorder is evident and is the reason for memory losses (Belmaker & Agam, 2008). The best solution for this case is to make the patient feel as if the facility is her home.
Belmaker, R. H., & Agam, G. (2008). Major depressive disorder. N Engl j Med, 2008(358), 55-68.
Carney, R. M., Rich, M. W., Freedland, K. E., Saini, J., Simeone, C., & Clark, K. (1988). Major depressive disorder predicts cardiac events in patients with coronary artery disease. Psychosomatic Medicine, 50(6), 627-633.
Hasin, D. S., Goodwin, R. D., Stinson, F. S., & Grant, B. F. (2005). Epidemiology of major depressive disorder: results from the National Epidemiologic Survey on Alcoholism and Related Conditions. Archives of general psychiatry, 62(10), 1097-1106.
Nelson, J. C., & Charney, D. S. (1981). The symptoms of major depressive illness. Am J Psychiatry, 138(1), 1-13.
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